Osteochondral Autograft Transfer Research Articles

Osteochondritis Dissecans of the Knee: Short-Term Outcomes of a Hybrid Technique to Restore a Partially Salvageable Progeny Fragment.

This retrospective case series describes a hybrid fixation technique and determines the clinical outcomes, knee function, and activity level of patients at short-term follow-up. Seventeen patients (18 knees) with unstable osteochondritis dissecans (OCD) lesions involving the knee were treated with a hybrid fixation technique in which the salvageable fragment was fixed and osteochondral autograft transplantation system (OATS) was used for the unsalvageable fragment. Thirteen lesions involved the medial femoral condyle, 4 involved the lateral femoral condyle, and 1 involved the patella. Mean patient age was 17 years (range 12-28 years). All lesions were International Cartilage Repair Society (ICRS) grade III or IV. The patients were prospectively followed postoperatively. Outcome measures included the International Knee Documentation Committee (IKDC) score, Knee injury and Osteoarthritis Outcome Score (KOOS), and the Tegner activity scale. At mean follow-up of 36 months (range 24-67.2 months), the mean postoperative KOOS scores, given as mean (SD), were as follows: Quality of Life (QoL) 91.1 (17.0), Activities of Daily Living (ADL) 99.5 (1.5), Sport 94.5 (11.2), Pain 97.4 (5.8), and Symptoms 95.9 (6.5). Mean IKDC score was 96.2 (7.0). There was no significant difference between mean preinjury (7.95, SD = 1.1) and mean postoperative (7.45, SD = 1.5) Tegner scores (P = 0.363). The mean Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score was 87.5 at a mean 7.8 months (range 3-18 months) postoperation. There were no reported complications. The results of this case series suggest that patients with partially salvageable OCD lesions involving the knee can have positive short-term outcomes and can expect a low complication rate when treated with a hybrid technique of fixation with osteochondral autograft transfer.

Preoperative Outcome Scores are Predictive of Achieving the Minimal Clinically Important Difference After Treatment of Focal Cartilage Defects of the Knee with Osteochondral Grafts

Objectives:Osteochondral autograft transfer (OAT) and fresh osteochondral allograft transplantation (OCA) are popular cartilage restoration techniques that involve the single-stage implantation of viable, mature hyaline cartilage into focal chondral defects of the knee. Both techniques have demonstrated good results, as defined by statistically significant post-surgical improvements in patient-reported outcome measures. Recently, there has been greater focus on what represents a clinically relevant change in outcomes reporting, and commonly applied metrics for measuring clinical significance, such as the minimal clinically important difference (MCID) and substantial clinical benefit (SCB), have become the standard. Although a previous study defined a MCID in patients treated for articular cartilage defects in the knee (Greco et al, AJSM 2010), these patients were treated with various cartilage restoration procedures (e.g., debridement, microfracture, autologous chondrocyte implantation), and none were treated with OAT/OCA. Therefore, the purpose of this study was to define the MCID and SCB thresholds after OAT/OCA for the International Knee Documentation Committee subjective knee form (IKDC) and Knee Outcome Survey-Activities of Daily Living Scale (KOS-ADL) and to determine clinical and demographic patient factors predictive for achieving the MCID and SCB after OAT/OCA.Methods:A prospective institutional cartilage registry was reviewed to identify patients who underwent OAT/OCA. The IKDC and KOS-ADL were administered preoperatively and at a minimum of 2 years postoperatively. The MCID and SCB of these outcome scores were calculated using anchor-based methods. Receiver operative characteristic (ROC) analysis was used to determine the SCB using an anchor question, with the area under the curve (AUC) used to evaluate predictive ability. Multivariate analysis was performed to identify patient factors associated with achieving the MCID and SCB.Results:In total, 173 knees in 173 patients (mean age, 33.0 ± 13.2 years; 37.0% female) were identified. Patient demographics and clinical variables are listed in Table 1. Using the anchor-based method, the MCID for the IKDC and KOS-ADL were 17 ± 3.9 and 10 ± 3.7, respectively. Using the ROC method, the SCB for the IKDC and KOS-ADL were 32 (AUC 0.86) and 10 (AUC 0.76), respectively. Univariate analysis demonstrated no association between procedure (OAT or OCA) or lesion location and likelihood of achieving the MCID/SCB. In multivariate analysis, lower preoperative IKDC scores and higher preoperative Marx Activity Scale scores were predictive of achieving an MCID and SCB on the IKDC, and lower preoperative KOS-ADL scores, lower preoperative SF-36 pain subscale scores, and a history of 1 or less previous ipsilateral knee surgeries were predictive of achieving a MCID and SCB on the KOS-ADL (Table 2).Conclusion:In patients treated for focal cartilage defects of the knee with osteochondral grafts, these values can be used to define a clinically important change and substantial clinical benefit for future outcome studies. In this study population, higher preoperative activity levels and a history of 1 or less previous ipsilateral knee surgeries were predictive of achieving a clinically important change and substantial clinical benefit after OAT/OCA. These findings have implications for managing preoperative expectations of OAT/OCA surgery.Table 1.Patient Demographics and Clinical Variables of Included Patients (N = 173)Age, y33 ± 13.2 Mean ± SD56 (32.4) Age <40 y64 (37.0)Female sex25.8 ± 4.5Body mass index, kg/m2 1.3 ± 1.5No. of previous surgeriesChondral lesion characteristics Lesion location Medial femoral condyle79 (45.7) Lateral femoral condyle59 (34.1) Trochlea28 (16.2) Patella30 (17.3) Lesion area, cm2 4.3 ± 2.6Procedure Osteochondral autograft transfer75 (43.4) Osteochondral allograft transplantation98 (56.7)Concomitant procedures ACLR2 (1.2) Meniscus allograft transplantation7 (4.0) Realignment osteotomy17 (9.8)Data are reported as n (%) unless otherwise indicated. ACLR = anterior cruciate ligament reconstructionTable 2.Multivariable Logistic Models for Achieving MCID and SCBOdds Ratio (95% CI)P ValueAchieving MCID on IKDC Age (≥40 y/<40 y)1.01 (0.43-2.40)0.985 Sex (Female/Male)0.96 (0.43-2.18)0.923 Preoperative IKDC0.95 (0.92-0.98)0.001 Preoperative Marx Activity Scale1.11 (1.03-1.19)0.005Achieving SCB ON IKDC Age (≥40 y/<40 y)0.60 (0.24-1.40)0.244 Sex (Female/Male)0.69 (0.31-1.50)0.360 Preoperative IKDC0.95 (0.92-0.98)0.001 Preoperative Marx Activity Scale1.14 (1.07-1.23)<0.001Achieving MCID and SCB on KOS-ADL Age (≥40 y/<40 y)0.92 (0.40-2.12)0.845 Sex (Female/Male)1.46 (0.67-3.24)0.343 Previous Knee Surgeries (>1/≤1)0.32 (0.14-0.69)0.005 Preoperative KOS-ADL0.96 (0.93-0.99)0.009 Preoperative SF-36 Pain Subscale0.98 (0.96-1.00)0.043IKDC = International Knee Documentation Committee Subject Form; KOS-ADL = Knee Outcome Survey - Activities of Daily Living Scale; MCID = minimal clinically significant difference; SCB = substantial clinical benefit

Long-term evaluation of Primary Osteochondral Autograft Transfer System (OATS) for large cystic type osteochondral lesion of talus

Category: Ankle Introduction/Purpose: Osteochondral lesions of talus (OLTs) are often treated primarily by fragment excision, abrasion, drilling, or microfracture. However, OLT accompanying with large cyst has been challenged to yield good outcome nevertheless of many surgical options. Recent study showed significant high failure rate of arthroscopic marrow stimulation treatment larger than 150mm2. The current study is to investigate the outcome of the primary osteochondral autograft transfer system (OATS) for large cystic type OLT (&gt;150mm2). Methods: This retrospective analysis included 19 talus (19 patients) with diagnosed large cystic type OLT (&gt;150mm2) who received primary OATS between September 2009 and March 2013. Defect size area was measured on magnetic resonance imaging (MRI) by the ellipse formula from coronal and sagittal length. The patients completed the visual analog scale (VAS) and the American Orthopaedic Foot &amp; Ankle Society (AOFAS) score preoperatively and at follow-up. Plain radiographs were used to show the improvement of radiolucency postoperatively. Results: The mean follow up period was 83.9 months (57 – 99) and the average defect size area was 169.4 mm2 (151.3 – 392.6). The Mean VAS score decreased from 6.95 preoperatively to 2.6 postoperatively. Average AOFAS score improved from 66.8 preoperatively to 88.7 postoperatively. Eighty percent of patients rated their result excellent or good. The radiolucent area of the cysts disappeared on the plain radiographs in all cases. Conclusion: Long-term clinical results of primary OATS in large cystic type OLT showed good outcomes and patients could significantly benefit from this surgery.

Osteochondral Autograft Transfer Combined with Periarticular Osteotomy for the Treatment of Osteochondral Defect of the Talus in Varus Ankle

Category: Ankle Introduction/Purpose: Osteochondral lesion of the talus (OLTs) is among the most common foot and ankle disorders. Varus ankle malalignment causes stress concentration on medial side of the joint, resulting in OLTs and osteoarthritis. For large symptomatic OLTs (&gt; 15 mm in diameter) involving posteromedial aspect of talar dome, osteochondral autograft transplantation is usually warranted. This article highlights the distal tibial double osteotomy for the management of patient with concomitant large OLTs and varus ankle malalignment. Methods: From January 2012 to July 2015, 15 patients (8 males, 7 females) received the surgery in our department. The average age was 55.4 (range, 34 to 69) years old. Oblique medial malleolar osteotomy was performed to expose the talar lesion, following by osteochondral autograft transplantation and distal tibial opening-wedge osteotomy. Weight bearing X-rays were obtained for the measurement of tibial articular surface (TAS) angle and tibial lateral surface (TLS) angle. The American Orthopaedic Foot and Ankle Society-Ankle and Hindfoot (AOFAS-AH) questionnaires and Visual Analog Scale (VAS) were evaluated for ankle function. In 5 cases arthroscopy was performed 12 months postoperatively and the cartilage repair was assessed with the criteria of the International Cartilage Repair Society. Results: Thirteen patients completed the follow-up with a mean of 21.2 months. The average talar lesion was 170.0mm2, and the average depth was 11.4 mm. The mean time of bone healing was 8.5 weeks. No patient reported donor site morbidity by the last follow-up. The mean AOFAS-AH score and VAS score improved from 53 to 90 points (p &lt; 0.05), 6.7 to 1.9 points (p &lt; 0.05), respectively. The mean TAS angle improved from 83.1 to 90.3 degrees (p &lt; 0.05). The radiolucent area of the cysts disappeared on the plain radiographs in all cases. The mean International Cartilage Repair Society arthroscopic score from follow-up arthroscopy was (9±1) points. Conclusion: The use of osteochondral autograft transfer combined with supramalleolar osteotomy is an effective option for the treatment of osteochondral defect of the talus in varus ankle. It provides excellent visualization of the talar defect and favorable biomechanical environment for the ankle joint.

Osteochondral Allograft Transplantation and Osteochondral Autograft Transfer

Cartilage defects commonly occur in young, active patients and can be debilitating injuries with patients experiencing significant pain and swelling. Clinical diagnosis is made using a combination of patient history, physical exam, imaging, and diagnostic arthroscopy. In patients who have failed conservative measures such as physical therapy, tolerable lifestyle modification, and injection treatments, surgical options exist including microfracture, autologous chondrocyte implantation, osteochondral autograft transfer, or osteochondral allograft transplantation. In this article, we present the diagnosis, indications, surgical technique, and reported outcomes for the treatment of cartilage defects with both osteochondral autograft transfer and osteochondral allograft transplantation.

Treatment of Failed Articular Cartilage Reconstructive Procedures of the Knee: A Systematic Review.

Background:Symptomatic articular cartilage lesions of the knee are common and are being treated surgically with increasing frequency. While many studies have reported outcomes following a variety of cartilage restoration procedures, few have investigated outcomes of revision surgery after a failed attempt at cartilage repair or reconstruction.Purpose:To investigate outcomes of revision cartilage restoration procedures for symptomatic articular cartilage lesions of the knee following a previously failed cartilage reconstructive procedure.Study Design:Systematic review; Level of evidence, 4.Methods:A literature search was performed by use of the PubMed, EMBASE, and MEDLINE/Ovid databases for relevant articles published between 1975 and 2017 that evaluated patients undergoing revision cartilage restoration procedure(s) and reported outcomes using validated outcome measures. For studies meeting inclusion criteria, relevant information was extracted.Results:Ten studies met the inclusion criteria. Lesions most commonly occurred in the medial femoral condyle (MFC) (52.8%), with marrow stimulation techniques (MST) the index procedure most frequently performed (70.7%). Three studies demonstrated inferior outcomes of autologous chondrocyte implantation (ACI) following a previous failed cartilage procedure compared with primary ACI. One study comparing osteochondral allograft (OCA) transplant following failed microfracture (MFX) with primary OCA transplant demonstrated similar clinical outcomes and graft survival at midterm follow-up. No studies reported outcomes following osteochondral autograft transfer (OAT) or newer techniques.Conclusion:This systematic review of the literature reporting outcomes following revision articular cartilage restoration procedures (most commonly involving the MFC) demonstrated a high proportion of patients who underwent prior MST. Evidence is sufficient to suggest that caution should be taken in performing ACI in the setting of prior MST, likely secondary to subchondral bone compromise. OCA appears to be a good revision treatment option even if the subchondral bone has been violated from prior surgery or fracture.

Clinical Outcomes of Meniscal Allograft Transplantation With or Without Other Procedures: A Systematic Review and Meta-analysis

Background: While additional procedures correcting accompanying pathological conditions can improve the clinical outcomes of meniscal allograft transplantation (MAT), whether those outcomes are comparable or poorer than those of isolated MAT has yet to be clarified. Purpose: To evaluate whether there is a difference in clinical outcomes between isolated MAT and MAT combined with other procedures (combined MAT). Study Design: Meta-analysis and systematic review. Methods: For the comparison of clinical outcomes between isolated MAT and combined MAT, the authors searched MEDLINE, Embase, and the Cochrane Library. Studies that separately reported the clinical outcomes of isolated MAT and combined MAT were included. Clinical outcomes were evaluated in terms of patient-reported outcomes (PROs) and complication, reoperation, survivorship, and failure rates. We conducted a meta-analysis of the PROs that were used in more than 3 studies. Results: A total of 24 studies were included in this study. In the meta-analysis, no significant differences in Lysholm scores (95% CI, –5.92 to 1.55; P = .25), Tegner activity scores (95% CI, –0.54 to 0.22; P = .41), International Knee Documentation Committee subjective scores (95% CI, –5.67 to 3.37; P = .62), and visual analog scale scores (95% CI, –0.15 to 0.94; P = .16) were observed between isolated MAT and combined MAT. For PROs that were not included in the meta-analysis, most studies reported no significant difference between the 2 groups. As for the survivorship and failure rates, studies showed varying outcomes. Four studies reported that additional procedures did not affect MAT failure or survivorship. However, 3 studies reported that ligament surgery, realignment osteotomy, and osteochondral autograft transfer were risk factors of failure. One study reported that the medial MAT group in which high tibial osteotomy was performed showed a higher survival rate than the isolated medial MAT group. Conclusion: Overall, there seems to be no significant difference between the postoperative PROs in terms of isolated MAT and combined MAT. However, more data are required to verify the effects of osteotomy and cartilage procedures on the clinical outcomes of MAT. We could not draw conclusions about the differences in complication, reoperation, survivorship, and failure rates between the 2 groups because we did not obtain sufficient data.

Arthroscopic Management of Isolated Tibial Plateau Defect With Microfracture and Micronized Allogeneic Cartilage–Platelet-Rich Plasma Adjunct

Articular cartilage lesions of the tibial plateau are an uncommonly encountered clinical entity, and they have been comparatively less well studied than femoral condyle or patellofemoral defects. The management of these lesions is complicated by the challenging geometry, difficult surgical approach, and proximity to important anatomic structures, and thus, treating these lesions by previously established methods, such as osteochondral allograft transplantation or osteochondral autograft transfer, can be a technically challenging endeavor. These lesions remain readily available to undergo microfracture, and this is the preferred method of management in the senior author's practice. Although less technically difficult and less invasive than other techniques, microfracture is currently limited by concerns over the long-term durability of the method. Current research seeks to improve the quality of cartilage fill stimulated by microfracture, and adjunct techniques have become increasingly popular. In this technical report, we present a technique for arthroscopic treatment of an isolated tibial plateau defect with microfracture using a micronized allogeneic cartilage (BioCartilage; Arthrex, Naples, FL) and platelet-rich plasma adjunct.

Osteochondral autograft transfer combined with supramalleolar osteotomy for the treatment of osteochondral defect of the talus in varus ankle

Category: Ankle, Ankle Arthritis, Arthroscopy, Sports Introduction/Purpose: Osteochondral lesion of the talus (OLTs) is among the most common foot and ankle disorders. Varus ankle malalignment causes stress concentration on medial side of the joint, resulting in OLTs and osteoarthritis. For large symptomatic OLTs (&gt; 15 mm in diameter) involving posteromedial aspect of talar dome, osteochondral autograft transplantation is usually warranted. This article highlights the distal tibial double osteotomy for the management of patient with concomitant large OLTs and varus ankle malalignment. Methods: From January 2012 to July 2015, 15 patients (8 males, 7 females) received the surgery in our department. The average age was 55.4 (range, 34 to 69) years old. Oblique medial malleolar osteotomy was performed to expose the talar lesion, following by osteochondral autograft transplantation and distal tibial opening-wedge osteotomy. Weight bearing X-rays were obtained for the measurement of tibial articular surface (TAS) angle and tibial lateral surface (TLS) angle. The American Orthopaedic Foot and Ankle Society-Ankle and Hindfoot (AOFAS-AH) questionnaires and Visual Analog Scale (VAS) were evaluated for ankle function. In 5 cases arthroscopy was performed 12 months postoperatively and the cartilage repair was assessed with the criteria of the International Cartilage Repair Society. Results: Thirteen patients completed the follow-up with a mean of 21.2 months. The average talar lesion was 170.0mm2, and the average depth was 11.4 mm. The mean time of bone healing was 8.5 weeks. No patient reported donor site morbidity by the last follow-up. The mean AOFAS-AH score and VAS score improved from 53 to 90 points (p &lt; 0.05), 6.7 to 1.9 points (p &lt; 0.05), respectively. The mean TAS angle improved from 83.1 to 90.3 degrees (p &lt; 0.05). The radiolucent area of the cysts disappeared on the plain radiographs in all cases. The mean International Cartilage Repair Society arthroscopic score from follow-up arthroscopy was (9±1) points. Conclusion: The use of osteochondral autograft transfer combined with supramalleolar osteotomy is an effective option for the treatment of osteochondral defect of the talus in varus ankle. It provides excellent visualization of the talar defect and favorable biomechanical environment for the ankle joint.

Ipsilateral femoral head osteochondral transfers for osteochondral defects of the femoral head.

Osteochondral defects of the femoral head are rare. Several treatment options have been described, though there is currently no consensus on the appropriate management of these lesions. Five patients underwent femoral head osteochondral autograft transfer for treatment of ipsilateral femoral head osteochondral defects via surgical hip dislocation between 2011 and 2014 at our institution. The mean age of the patients was 24.8 (16–37) years. There were four females and one male. Mean follow-up was 53.8 (30–64) months. Four patients reported complete resolution of preoperative pain, return to baseline activities and were satisfied with their results. Harris hip scores improved from a mean 60.8 (30–87) to 86.6 (44–100). There was no radiographic evidence of progression of the femoral head defects. There were no operative complications. Osteochondral autograft transfer from the ipsilateral femoral head using a surgical hip dislocation demonstrated good clinical and radiographic outcomes at midterm follow-up in our cohort and may be considered a suitable option for management of these lesions in select patients. Further research and follow-up is warranted to more clearly define the indications and outcomes of this procedure.

Surgical Technique and Clinical Outcomes of Retrograde Osteochondral Autograft Transfer for Osteochondral Lesions of the Tibial Plateau

To present the surgical technique, clinical outcomes, and poor prognostic factors of arthroscopic retrograde osteochondral autograft transfer of the tibial plateau. Twelve patients (6 men, 6 women; mean age, 38.7years) with tibial plateau osteochondral lesions underwent surgery. The primary diseases were osteonecrosis in 4 cases, cartilage injuries in 6, and postfractures of the tibial plateau in 2. Clinical outcomes were evaluated preoperatively and postoperatively according to the International Knee Documentation Committee score and the Japanese Orthopaedic Association score. The International Cartilage Repair Society score was recorded in 7 cases who underwent second-look arthroscopies postoperatively. Statistical analyses were performed to identify prognostic factors associated with the clinical outcomes. The mean International Knee Documentation Committee and Japanese Orthopaedic Association scores were both significantly improved from 39.0 (range, 13.0-57.1) to 72.4 (range, 33.3-100) (P= .0022) and from 65.8 (range, 30.0-85.0) to 85.8 (range, 50.0-100) (P= .0022 < .05), respectively. In 2 cases, secondary operations were performed because of knee pain (1 varus osteotomy of the femur and 1 total knee replacement). The mean International Cartilage Repair Society scores were significantly worse in the 2 cases who required a secondary operation (3.5; abnormal) than in the 5 cases who did not (10.6; nearly normal). The secondary operation rate was significantly higher in cases with lesion size ≥400mm2 than in those <400mm2 (Fisher's exact test; P= .046). Most clinical scores improved significantly postoperatively. The results indicate that arthroscopic retrograde osteochondral autograft transfer is an effective procedure to achieve sufficient cartilage congruity for osteochondral lesions of the tibial plateau <400mm2 in size. Level IV, therapeutic case series.

2017

Posteriorly based osteochondral lesions of the talus (OCLTs) are relatively rare, and when they are symptomatic and not amenable to traditional arthroscopic treatment techniques, they may require osteochondral graft transfer procedures, such as the osteochondral autograft transfer system (OATS) procedure. Historically described osteotomies to gain perpendicular access to these OCLTs, while excellent techniques, present many possible postoperative morbidities. This technical tip describes the use of a prone position midline Achilles tendon-splitting approach, a well-described approach to the posterior ankle and hindfoot, to perform osteochondral autograft transfer without need for any malleolar osteotomies. At 12 months postoperatively, the patient reported a pain visual analog score of 1.0 (75% improvement) and demonstrated an American Orthopaedic Foot and Ankle Society ankle and hindfoot score of 90 (38% improvement). At 24 months postoperatively, the patient had near complete resolution of ankle pain and had returned to normal recreational physical activities.

Osteochondritis dissecans of the elbow: state of the art

Osteochondritis dissecans (OCD) of the elbow is localised most commonly at the capitellum. It is a localised condition of the subchondral bone which may result in segmentation and separation. Irreversible changes, pain, restriction of motion and limitation of activities may result because of this. Elbow OCD afflicts athletes in the second decade, especially adolescents engaged in repetitive elbow overuse such as gymnasts, pitchers and swimmers. A high index of suspicion is warranted to prevent delay in the diagnosis. Imaging studies begin with standard elbow radiographs, but in later stages MRI or CT scan are indicated. Lesions are classified as ‘stable’ or ‘unstable’. In general stable lesions are treated conservatively, whereas unstable lesions are indicated for surgical management. Geographical variation exists in techniques for arthroscopic procedures for OCD of the elbow. In Europe and the USA most surgeons use classic arthroscopic debridement and microfracturing for lesions which are not amendable to a solid fixation, whereas in Australia some surgeons use dry arthroscopy for optimal assessment of the articular surface and the presence or absence of subchondral bone. In Japan fixation of the OCD with bone pegs is favoured. Numerous other surgical techniques have been reported, including internal fixation of large fragments and osteochondral autograft transfer. The aim of this article is to explore OCD of the elbow with regard to aetiology, clinical presentation, the diagnostics prior to the intervention, the different surgical techniques, possible complications and pitfalls, clinical outcome and future directions.

Osteochondral autograft transfer (OAT) combined with OWHTO for spontaneous osteonecrosis of the knee (SONK)

Osteochondral autograft transfer (OAT) combined with OWHTO for spontaneous osteonecrosis of the knee (SONK)

Arthroscopic results of the cartilage repair using fusion technique of island osteochondral autograft transfer (OAT) and microfracture for severe osteoarthritis in younger patients

Arthroscopic results of the cartilage repair using fusion technique of island osteochondral autograft transfer (OAT) and microfracture for severe osteoarthritis in younger patients

Osteochondral Autograft Transfer Technique for Glenoid Osteochondral Defect

Glenoid osteochondral defects can be a significant source of pain and disability in an active population. Many treatments are available, but most joint-preserving procedures are limited to debridement, abrasion chondroplasty, or marrow-stimulation techniques, all of which depend on healthy underlying bone and none of which address underlying bony pathology. Osteochondral autograft transfer has been a successful form of treatment for lesions in the knee, elbow, and ankle, especially when subchondral bone is involved. We describe an arthroscopic method of treating glenoid osteochondral lesions with an osteochondral autograft transfer using a graft from the patient's ipsilateral knee. This technique addresses both cartilage and osseous pathology with minimal morbidity and provides a good biological restorative option for patients with isolated glenoid osteochondral defects.

Outcomes of Patellofemoral Osteochondral Lesions Treated With Structural Grafts in Patients Older Than 40 Years.

Background Chondral lesions in the patellofemoral compartment represent a difficult entity to treat among active patients, with no clear consensus on the optimal treatment strategy. The purpose of this study was to review the functional outcomes of patients >40 years old with primary patellofemoral osteochondral lesions who underwent a cartilage restoration procedure with a structural graft. Methods Following institutional review board approval, 35 patients >40 years treated for patellofemoral chondral or osteochondral injuries were retrospectively identified. Seventeen (47%) had prior surgery (mean 1.4 procedures, range 1-4). Average follow-up was 3.6 ± 1.6 years. Average patient age was 51.5 years (range 40-72 years); 54% were male. Twenty-six (74%) had isolated trochlear lesions, 7 had isolated patellar lesions (20%), while 2 (6%) had bipolar lesions. Twenty patients (57%) were treated with synthetic biphasic scaffold plugs (SS), 9 (26%) with fresh osteochondral allograft (OCA) and 6 (17%) with osteochondral autograft transfer (OAT). Outcomes were measured with validated measures: Activity of Daily Living Score (ADL), International Knee Documentation Committee (IKDC) Subjective Evaluation form, and Marx Activity Scale (MAS). Results The average lesion size for the entire cohort was 3.1 ± 1.7 cm2. Average defect size was 2.6 ± 1.7 cm2 for the SS group, 4.3±1.5 cm2 for the OCA group, and 2.9 ± 0.8 cm2 for the OAT group ( P > 0.051). Outcome scores for the entire population demonstrated significant improvement in ADL ( P = 0.002) and IKDC scores ( P = 0.004) between baseline and final follow-up, while MAS scores were maintained ( P = 0.51). Conclusion Structural grafts are a viable treatment option for symptomatic focal osteochondral lesions of the patellofemoral joint in patients 40 years and older, with anticipated improvements in pain and function and maintenance of preoperative activity levels.

Return to sport after the surgical management of articular cartilage lesions in the knee: a meta-analysis.

Optimal surgical treatment of chondral defects in an athletic population remains highly controversial and has yet to be determined. The purpose of this review was to (1) report data on return to sport and (2) compare activity and functional outcome measures following various cartilage restoration techniques. A comprehensive review was performed for studies with return-to-sport outcomes after microfracture (MFX), osteochondral autograft transfer (OAT), osteochondral allograft transplantation (OCA), and autologous chondrocyte implantation (ACI). All studies containing return-to-sport participation with minimum 2-year post-operative activity-based outcomes were included. A meta-analysis comparing rate of return to sport between each surgical intervention was conducted using a random-effects model. Forty-four studies met inclusion criteria (18 Level I/II, 26 Level III/IV). In total,2549 patients were included (1756 M, 793 F) with an average age of 35years and follow-up of 47months. Return to sport at some level was 76% overall, with highest rates of return after OAT (93%), followed by OCA (88%), ACI (82%), and MFX (58%). Osteochondral autograft transfer showed the fastest return to sports (5.2±1.8months) compared to 9.1±2.2months for MFX, 9.6±3.0months for OCA and 11.8±3.8months for ACI (P<0.001). A meta-regression was conducted due to heterogeneity in preoperative factors such as patient age, lesion size, and preoperative Tegner score. None of these factors were found to be significant determinants for rate of return to sport. In conclusion, in this meta-analysis of 2549 athletes, cartilage restoration surgery had a 76% return to sport at mid-term follow-up. Osteochondral autograft transfer offered a faster recovery and appeared to have a higher rate of return to preinjury athletics, but heterogeneity in lesion size, athlete age, and concomitant surgical procedures are important factors to consider when assessing individual athletes. This study reports on the rate of return to sport in athletes undergoing various procedures for symptomatic chondral defects. IV.

ACI Versus Microfracture: The Debate Continues: Commentary on an article by Gunnar Knutsen, MD, PhD, et al.: "A Randomized Multicenter Trial Comparing Autologous Chrondrocyte Implantation with Microfracture: Long-Term Follow-up at 14 to 15 Years".

Because of the limited regenerative potential of articular cartilage, management of symptomatic chondral defects places us in a very challenging situation. The quest for the ideal treatment modality, in which mechanically functional hyaline cartilage can be regenerated around and in the defect site, is ongoing. In the last few years, multiple products and techniques that claim to provide improved outcomes, but have never been tested in controlled trials, have entered the market. Microfracture, autologous chondrocyte implantation (ACI), and the osteochondral autograft transfer system (OATS) have been around for the last 2 decades. They have been studied extensively, but Level-I studies are few in number. In a systematic review of Level-I and II studies, Magnussen et al. concluded that no 1 technique produces superior clinical results for these defects1. Results were found to be inconsistent and contradictory, which could be due to multiple factors such as heterogeneity of the study sample, location of lesions, associated procedures, and age of the lesion, to name …

Osteochondral Autograft Transfer Versus Microfracture in the Knee: A Meta-analysis of Prospective Comparative Studies at Midterm

To compare microfracture (MFX) and osteochondral autograft transfer (OAT) surgical techniques to determine (1) postoperative activity level, (2) subjective patient outcomes, (3) failure rates, and (4) assess if any lesion characteristics favored one technique over the other. A comprehensive review of literature was performed of all studies comparing MFX and OAT. Studies included were all prospective studies that reported on activity-based outcome measures such as Tegner activity scores and subjective outcomes such as the International Knee Documentation Committee score. Failure rates, as determined by the publishing authors, were recorded for each study. Meta-analyses were conducted using a random-effects model. Paired standardized mean differences (Hedges's g to account for small sample bias) were used for continuous outcome measures, and risk ratios (Mantel-Haenszel method for small sample bias) for dichotomous outcome measures. Six prospective studies satisfied the eligibility criteria and included 249 patients (186 male, 120 female) with an average age of 26.4years and follow-up of 67.2months. Tegner scores were superior in patients treated with OAT compared with MFX (ΔOAT-MFX for pre-post scores= 0.94 Tegner points, standardized mean difference [SMD]= 0.469, P= .005). Failure rates of MFX were higher than OAT (OAT= 11%, MFX= 32%, risk ratio= 2.42, P < .036). OAT was superior to MFX at 3years in relation to subjective outcome scores (SMD= 0.404, P= .008). When assessing OAT lesions larger than 3cm2, OAT was superior to MFX with respect to activity level (SMD= 0.506, P= .001). OAT may achieve higher activity levels and lower risk of failure when compared with MFX for cartilage lesions greater than 3cm2 in the knee, although there was no significant difference for lesions less than 3cm2 at midterm. However, because of variability in patient-specific factors such as age, preinjury activity level, lesion location and size, the superiority of OAT over MFX cannot be generalized to all patient populations and therefore requires individualized patient care. Level II, meta-analysis of Level I and II studies.